Registration Form Directions: Please Complete Registration Form and Return to Adopteebridge ([email protected] OR P.O

AdopteeBridge

Post Adoption Registration Form Directions: Please complete registration form and return to AdopteeBridge ([email protected] OR P.O. Box 13552, Roseville, MN 55113): ☐ Post Adoption Registration Form ☐ Copy of adoption paperwork (Initial Social History/Child Study/Adoptive Child Study Summary/Confidential Background) ☐Copy of identification (driver’s license, US passport, etc.) ☐ Items for translation—If requesting translation services

Upon receival of your registration form, we will contact you and discuss how to further proceed with your requests. Per Korean Post Adoption Policies & Regulations, additional items will be required to initiate your service requests.

Section 1: Applicant Information For adoptees 18 years and younger—applicant must be adoptive parent Full Legal Name:

Preferred Name: Preferred pronouns: Check applicable box (who you are): ☐ Adoptee ☐ Adoptive parent Mailing Address:

City State: Zip:

Email Phone:

Is it ok to leave voicemails at this number? ☐ Yes ☐ No

Section 2: Adoptee Information ADOPTEE INFORMATION Korean Name: Full legal name given by adoptive parents:

Preferred Name: Preferred pronouns:

Date of Birth: Placement Date (date of arrival to U.S.):

Korean Adoption Agency: U.S. Adoption Agency: ☐ Eastern Social Welfare Society—ESWS ☐ Children’s Home Society of Minnesota—CHSM (formerly Eastern Child Welfare Society) (Children’s Home Society and Family Services—CHSFS) ☐ Korea Welfare Society—KWS ☐ Adoption Service Information Agency—ASIA (formerly Social Welfare Society) ☐ Love the Children ☐ Holt Children’s Services—Holt ☐ Holt International Children’s Services ☐ Korea Social Service—KSS ☐ Other:

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AdopteeBridge

PARENT/GUARDIAN INFORMATION *All services requested by an adult adoptee will remain confidential unless a release form is signed. This information is used to help contact Korean adoption agency. Parent/Guardian Name 1:

Parent/Guardian Name 2:

Section 3: Post Adoption Request PLEASE SELECT BOXES BELOW: ☐ File Review ☐ Birth Parent Search ☐ Correspondence w/ previously located birth family ☐ Foster mother/family contact/correspondence ☐ Translation services ☐ Other (please list):

ADDITIONAL INFORMATION I am currently receiving Post Adoption Services at another agency: ☐ Yes ☐ No *if selecting “yes,” please indicate which agency:

I have received Post Adoption Services in the past: ☐ Yes ☐ No *if selecting “yes,” please indicate through which agency and the outcome of service requests:

I am planning a trip to Korea within the next 12 months: ☐ Yes ☐ No *if selecting “yes,” please indicate dates of travel:

Section 4: Clients Rights and Responsibilities

As a client of AdopteeBridge, you have the right… • To be treated with respect, dignity, consideration, and compassion • To receive services free of discrimination based on race, color, sex/gender, ethnicity, national origin, religion, age, class, sexual orientation, ability • To participate in creating a plan for Post Adoption Services • To be informed about available services and options • To withdraw voluntary consent to participate in Post Adoption Services • To have your adoption, post adoption, and case management records be treated confidentially • To have information released only in the following circumstances: o When you sign a written release of information o When there is a medical emergency o When a clear and immediate danger to you or to others exists o When there is possible child or elder abuse o When ordered by a court of law • To file a grievance about services you are receiving or denial of services • To not be subjected to physical, sexual, verbal and/or emotional abuse or threats

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AdopteeBridge

As a client of AdopteeBridge, you have the responsibility… • To treat other clients and staff of AdopteeBridge with respect and courtesy • To protect the confidentiality of other clients you encounter at AdopteeBridge • To participate as much as you are able in creating a plan for case management • To inform staff of any concerns or changes in your needs • To make and keep appointments to the best of your ability; or if possible, reschedule appointment prior to scheduled time • To stay in communication with staff by informing them of changes in your address or phone number and responding to staff’s contact to the best of your ability • To not subject AdopteeBridge’s staff, Board Members, or other clients to physical, sexual, verbal and/or emotional abuse or threats

☐ I have received the Client Rights & Responsibilities and understand my signature below is acknowledging receipt of this notice.

______Signature Printed Name

______Date

Section 5: Translation Services Release and Waiver By submitting text (letter(s), card(s), adoption document(s), etc.) for, or otherwise engaging in AdopteeBridge’s Translation Services program (“Services”), I hereby acknowledge, understand, and agree to the following terms and conditions:

1. I agree for myself, my executors, my administrators, and my successors to hereby waive and release any and all claims, including without limitation, any attorney’s fees, or other costs or expenses, or litigation, against AdopteeBridge and its respective officers, directors, members, volunteers and agents, from any and all liability, either in law or in equity, that may be sustained by me or my property, at any time, as a result of my use of Services, including claims known and unknown, foreseen or unforeseen, future or contingent. 2. BY SIGNING THIS AGREEMENT, IT IS MY EXPRESS INTENT TO RELEASE, WAIVE, HOLD HARMLESS, AND INDEMNIFY THE RELEASED PARTIES FROM ANY AND ALL LIABILITY CONNECTED WITH MY USE OF SERVICES (INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE) AND TO PERSONALLY ASSUME ALL RISK. 3. While AdopteeBridge has taken steps to ensure privacy and confidentiality, I understand that my disclosure of sensitive or confidential information is done so at my own risk. 4. I understand that Services will be finished in approximately 3-5 business days, though in some situations, items may take a shorter or longer period of time, depending on the length of the item I submitted for translation, the number of items already in the queue, and other factors. 5. Additionally, I understand that unless I specifically request so, my item will be translated by a volunteer and these translators are not professional translators and that Services are being provided to the best of their ability as a native or fluent Korean speaker.

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AdopteeBridge

My signature, voluntarily and freely given, indicates my understanding and assumption of all risks associated with my voluntary use of Services and my waiver of any claims against the Released Parties. I further acknowledge and represent that I have had sufficient time to consider the subject matter of this Agreement.

______Signature Printed Name

______Date

Section 6: Disclaimer and Signature I/we hereby acknowledge the above information is accurate to the best of my/our knowledge.

I/we grant permission to AdopteeBridge to act as an intermediary on the adoptee’s behalf in contacting the U.S. (if need be) and Korean placing agency in order to make the necessary arrangements needed for Post Adoption Services. I/we hereby give my/our consent to AdopteeBridge to release any or all information and items to agencies and organizations necessary in order to request Post Adoption Services. I/We assume full responsibility for whatever may result from this action. I/We will not hold AdopteeBridge responsible in any way for the results following the release of this information to any person, organization or governmental entity necessary for the delivery of Post Adoption Services. I/We understand this consent may be revoked with a written notice at any time, but that this written notice will not affect information the agency has already released.

I/we understand additional information, paperwork, and items are necessary in order to request Post Adoption Services from individual Korean adoption agencies.

______Signature Printed Name

______Date

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AdopteeBridge

Things to Consider Before You Search

Carefully consider your expectations • Why are you searching? • What are your expectations for the search process and the search result? • Are you looking for answers to questions, ongoing contact, a new relationship?

Be prepared for a variety of outcomes • What happens if your birth parent is not able to be found? • What happens if a birth parent does not wish to have contact? • What happens if a birth parent is deceased? • What if you find out information contradicts the information you thought was true all along?

Are you ready to not be in control? • The search process could take some time and involves a variety of agencies. • If a birth parent is found, they could take some time to decide to respond. • Are you ready to not be in full control of this search process?

Who is in your support network? • Who have you talked to about starting this search process? • It’s important to have a strong support network as you begin this search process as this can be an emotional journey. AdopteeBridge offers discussion groups and referrals to adoption competent counselors/therapists.

Be prepared for a variety of emotions • It is perfectly normal to go through a variety of emotions as you go through this search process— excitement, anger, anxiety, relief, frustration—these are all emotions that are commonly experienced. • No one emotion is right or wrong. • Each adoptee’s search process is unique and personal

Are you ready to learn about your birth culture? • With the search process, comes learning a bit about your birth culture—this is especially true if you decide to travel there. Are you prepared to learn about the customs of your birth country?

Is this YOUR choice? As adoptees we did not get to choose our adoptions. We did not choose to be relinquished. We did not choose to be adopted. The decision to search is one of the few things adoptees get to choose. It is a part of our adoption life journey; it is not our adoptive parents’ journey. There is a right time for everybody. It is a very individual thing. I would recommend you listen to your gut, your heart and have a clear mind. Do not listen to others who are enthusiastic about your search or reunion. Make sure the enthusiasm is yours. Do not feel pressured by your birth family or adoptive family to search or reunite until you are ready. Make sure that the choice is yours. Hollee McGinnis, “Ten Questions to Ask Yourself”

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